Provider Demographics
NPI:1508875139
Name:WALTERS, GEORGE RONALD (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:RONALD
Last Name:WALTERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 KING PALMS WAY
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-8970
Mailing Address - Country:US
Mailing Address - Phone:254-640-3855
Mailing Address - Fax:409-985-2915
Practice Address - Street 1:3000 39TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-5517
Practice Address - Country:US
Practice Address - Phone:409-985-2569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4749207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C23145Medicare UPIN